Individual provider Active NPI

Rebecca Helen Shide-Ferguson

  • Psychiatric/Mental Health Nurse Practitioner
  • Lakewood, WA
National Provider Identifier
1811464142
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP61234713 Issued in WA
Practice address
9330 59TH Ave SW
Lakewood, WA 98499-2858
Phone
(253) 581-7020
NPI assigned
Oct 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61234713 WA Primary

Addresses

Primary practice location

9330 59TH Ave SW
Lakewood, WA 98499-2858

Mailing address

9330 59TH Ave SW
Lakewood, WA 98499-2858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211222000320 WA Practitioner - Nurse Practitioner 4789075029 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Lakes Mental Health Foundation IncGroup PAC ID 7315836350, 19 clinicians

Practice addresses (Care Compare)

9330 59TH Ave SW
Lakewood, WA 98499-2858
Phone (253) 581-7020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
AP61234713WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Lakes Mental Health Foundation Inc CurrentSince Oct 28, 2021 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Oct 28, 2021 Accepting new patients
Multicare Health System CurrentSince Oct 28, 2021 Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

325 E Pioneer
Puyallup, WA 98372
Phone (253) 445-8120

9330 59th Ave SW
Tacoma, WA 98499
Phone (253) 581-7020

Interoperability endpoints

  • Direct secure messaging: rshide401091@direct.multicare.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1811464142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9330 59TH AVE SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 59TH AVE SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992858",
            "telephone_number": "253-581-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIDE-FERGUSON",
        "first_name": "REBECCA",
        "middle_name": "HELEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-24",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61234713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.